Angled tissue cutting instruments and method of fabricating angled tissue cutting instruments having flexible inner tubular members of tube and sleeve construction

ABSTRACT

An angled tissue cutting instrument comprises an angled outer tubular member rotatably receiving a flexible inner tubular member. The inner member has a flexible region in correspondence with an angle of the outer member. The flexible region comprises a helically cut length portion of an elongate tubular body of the inner member and a continuous solid flexible surface secured to an outer surface of the body along the helically cut length portion. A method of fabricating a flexible inner tubular member involves forming a helical cut through the solid wall of a length portion of a tubular body and securing a continuous solid flexible surface to the outer surface of the body along the helically cut length portion to form a flexible region.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to tissue cutting instrumentshaving an elongate inner member rotatably disposed in an elongate outertubular member to cut anatomical tissue and, more particularly, toangled tissue cutting instruments and methods of fabricating angledtissue cutting instruments having an elongate flexible inner tubularmember rotatably disposed in an elongate angled outer tubular member.

2. Discussion of the Related Art

Surgical cutting instruments in which an elongate inner member isrotated within an elongate outer tubular member have become wellaccepted in surgical procedures where access to a cutting site in apatient's body is gained via a narrow or small size natural orsurgically created anatomical opening or passage establishingcommunication with the cutting site from externally of the patient'sbody. Typically, the outer tubular member includes a distal end with anopening defining a cutting port or window, and the inner member includesa distal end carrying a cutting configuration exposed by or from thecutting port for engaging anatomical tissue at the cutting site.Proximal ends of the inner and outer members ordinarily include hubswhich attach to a powered handpiece disposed externally of the patient'sbody and having a motor for rotating the inner member relative to andwithin the outer member. The cutting configuration of the inner membercan have various configurations depending upon the surgical procedure tobe performed, the type of tissue to be cut and/or the desired cuttingaction. The opening in the distal end of the outer member may besuitably configured to cooperate with the particular cuttingconfiguration of the inner member to cut anatomical tissue. Often theinner member is tubular and has an aspiration port at its distal endcommunicating with the lumen of the inner tube so that material,including loose tissue resulting from a cutting procedure, can beaspirated from the cutting site through the aspiration port and lumen ofthe inner member. Many tissue cutting instruments are designed to allowirrigating fluid to flow along the instruments for discharge at thecutting site, and some tissue cutting instruments are designed for flowof irrigating fluid between the outer and inner members. It isadvantageous in tissue cutting instruments for the direction of rotationof the inner member to be reversible during operation for operation ofthe instruments in both forward and reverse rotational directions. Anexample of a rotary tissue cutting instrument of the aforementioned typeis described in U.S. Pat. No. 4,203,444 to Bonnell et al for use inperforming arthroscopic knee surgery.

Many tissue cutting instruments are straight, with longitudinally oraxially straight inner and outer members as represented by the Bonnellet al patent. In straight tissue cutting instruments, it is typical forthe outer tubular member to comprise an outer tube and for the innertubular member to comprise an inner tube having an outer diameter forbeing accommodated in the inner diameter of the outer tube whileallowing the inner tube to rotate within the outer tube. Typically,there is a small annular gap or clearance between the outer diameter ofthe inner tube and the inner diameter of the outer tube, and irrigatingfluid may flow along the irrigation channel defined by this gap orclearance for discharge through the cutting port. The lumen of the innertube defines the aspiration passage in communication with the aspirationport at the distal end of the inner tube and through which material isaspirated when suction is produced in the lumen of the inner tube. Sincean elongate body of the straight inner tube is normally of unbrokensolid wall construction, there are no openings through the wall of thebody of the inner tube through which suction in the aspiration passagemay be lost and/or through which irrigating fluid may be drawn into theaspiration passage.

In many surgical procedures, it is advantageous for the tissue cuttinginstruments to be non-straight or angled to access cutting sites whichare not accessible or are more difficult to access with straight tissuecutting instruments. Angled tissue cutting instruments normally comprisean elongate angled outer tubular member and an elongate flexible innertubular member which conforms to the angled configuration of the outermember while being rotatable therein. The angled configuration of theouter member can be formed by various angles, bends or curves, aslimited by the ability of the flexible inner tubular member to bend. Aswith straight tissue cutting instruments, irrigating fluid may flowthrough an irrigation channel between the angled outer tubular memberand the flexible inner tubular member, and aspiration may be conductedthrough an aspiration passage of the flexible inner tubular member.

The flexible inner tubular members of many angled tissue cuttinginstruments utilize spirally or helically wound coils or springs totransmit torque to rotate the cutting configuration when the innermembers are rotated within the outer members. Flexible inner membersthat employ a single spirally or helically wound coil to impartflexibility while transmitting torque are represented by U.S. Pat. No.4,466,429 to Loscher et al and U.S. Pat. No. 4,445,509 to Auth. A singlecoil tends to unwind when rotated in a direction opposite its winding sothat torque can only be transmitted efficiently in one rotationaldirection. Accordingly, angled tissue cutting instruments utilizing thistype of flexible inner member cannot be operated in both forward andreverse rotational directions.

Flexible inner tubular members having a plurality of coaxial spirally orhelically wound coils disposed one on top of the other and wound inalternating opposite directions relative to one another have been usedin angled tissue cutting instruments to transmit torque in bothrotational directions. U.S. Pat. No. 4,646,738 to Trott describes anangled tissue cutting instrument in which the flexible inner tubularmember comprises separate distal and proximal end portions and acomposite spiral interposed between the distal and proximal end portionsto allow the inner tubular member to bend. The composite spiral issimilar to the flexible shaft disclosed in U.S. Pat. No. 177,490 toFones et al and is made up of an inner spiral, a middle spiral and anouter spiral arranged one on top of the other with their windingsalternating in direction. The distal and proximal end portions includereduced diameter neck portions which are telescopically received withinopposite ends of the inner spiral to facilitate welding of the distaland proximal end portions to opposite ends of the composite spiral. Eachspiral adds material and labor costs to the flexible inner tubularmember and, therefore, to the angled tissue cutting instrument. Anotherdisadvantage of the flexible inner tubular member used in the Trottinstrument is that the neck portions tend to stiffen the compositespiral in the vicinity of the cutting tip thereby preventing the innermember from bending adjacent the cutting tip. In addition, it ispossible for the separate components to become detached from one anotherduring use such that torque can no longer be effectively transmitted tothe cutting configuration. Angled tissue cutting instruments in whichthe flexible inner tubular member is like that disclosed in the Trottpatent are described in U.S. Pat. No. 5,286,253 to Fucci and U.S. Pat.No. 5,529,580 to Kusunoki et al.

U.S. Pat. No. 5,314,438 to Shturman and U.S. Pat. No. 6,217,595 toShturman et al relate to a flexible drive shaft comprising inner andouter oppositely wound helical wire layers along the entire length ofthe drive shaft. The drive shaft of the Shturman patent is referred toin the Shturman et al patent as being difficult and time-consuming tomanufacture. The drive shaft of the Shturman et al patent has its outerhelical layer made up of a single wire and its inner helical layer madeup of a plurality of wires, which must all be wound around a formingmandrel so that the drive shaft requires many parts and is stilldifficult and time-consuming to manufacture. Flexible shafts or tubularmembers comprising two layers of helical windings or coils have many ofthe same disadvantages as flexible tubular members that have threehelical windings or coils.

Another disadvantage associated with the use of helical coils or springsto transmit torque while imparting flexibility is that spaces or gapsbetween the coils may be presented along the body of the flexible innertubular member which allow suction in the lumen or aspiration passage ofthe inner tubular member to be dissipated such that less suction isapplied at the aspiration port for reduced aspiration efficiency. Aweakened suction force or vacuum in the aspiration passage and/or at theaspiration port may lead to clogging or jamming of the tissue cuttinginstrument due to tissue build-up. Clogging or jamming of tissue cuttinginstruments due to tissue build-up undesirably leads to the need forfrequent cleaning or substitution of the instruments during use, whichis time consuming and increases the duration of the surgical procedureto the detriment of the patient and the surgeon. Loss of irrigationefficiency is another problem where spaces are presented between thecoils, since irrigating fluid flowing between the outer and innermembers may be drawn through the spaces into the aspiration passage. Anadditional drawback of helical coils or springs is the tendency of thecoils or springs to require tightening or preloading. Furthermore, coilsor springs have a tendency under certain loading conditions to relax orunwind, and thus expand, thereby increasing the possibility of the innermember binding within the outer member. Relaxation of the coils orsprings also makes it more likely that sizable spaces or gaps will bepresented between the coils, especially on bending, through whichsuction in the lumen of the inner member may be lost and/or throughwhich irrigating fluid flowing between the inner and outer members maybe drawn into the inner member lumen.

U.S. Pat. No. 5,922,003 to Anctil et al relates to an angled tissuecutting instrument and to a method of fabricating an angled tissuecutting instrument in which the flexible inner tubular member has aflexible region interposed between a drive shaft and a cutting tip. Theflexible region includes a flexible polymeric tube having ends thatreceive necks of the drive shaft and cutting tip, respectively. A collarof heat shrink tubing is disposed over each end of the tube. When heatis applied, the collars shrink and the polymeric material is caused toflow into slots in the necks to form a mechanical joint. The heat shrunktubing may be removed after the polymeric material has cured. Counterwound wires embedded in the polymeric material assist in transmittingtorque in forward and reverse rotational directions.

Another approach to flexible inner tubular members of angled tissuecutting instruments has involved forming relief apertures or slotsthrough the walls of solid inner tubes to impart flexibility to theinner tubes as represented by U.S. Pat. No. 5,152,744 and U.S. Pat. No.5,322,505 to Krause et al. In the angled tissue cutting instrumentsdescribed in the aforementioned Krause et al patents, the inner tubeshave discrete, unconnected apertures or slots formed therein such thattorque transmission is limited. Also, the slots present spaces throughwhich fluid can flow to and from the lumen of the inner tube.

U.S. Pat. No. 5,807,241 to Heimberger discloses a flexible tubeparticularly useful as a shank for a flexible endoscope. The flexibletube is formed by cutting a gap in a closed path in a longitudinallystraight solid tube to form interlocking but completely materially orphysically separated tube sections that allow the tube to bend axially.The flexible tube may not be well suited for use as a rotatable innertubular member of a surgical cutting instrument since its torquecapabilities may be limited to relatively low single direction andbidirectional rotational speeds. Additionally, it is possible for theindividual tube sections to disconnect or become detached when the tubeis bent. Spaces are presented between the individual tube sectionsallowing the exchange of fluid between the outside and the inside of thetube.

Angled tissue cutting instruments having inner tubes with continuoushelical cuts therein to impart flexibility are illustrated by U.S. Pat.No. 6,053,922 to Krause et al, No. 6,312,438 B1 to Adams and No.6,533,749 B1 to Mitusina et al. In the angled tissue cutting instrumentsdisclosed by Krause et al '922, no additional layer of material issecured over the helically cut inner tube. Accordingly, the instrumentmay be suitable for transmitting torque in one direction only and may beof limited torsional strength, as well as the helical cut presenting aspace through the wall of the inner tube through which fluid may flow.The angled tissue cutting instruments described in the Adams andMitusina et al patents have flexible inner tubular members includingflexible regions formed by a helical cut in an inner tube and two spiralwrap layers disposed over the helical cut in the inner tube one on topof the other in alternating directions. The instruments disclosed in theAdams and Mitusina et al patents overcome the primary disadvantages ofwound helical coils or springs and can effectively transmit torque inboth rotational directions at relatively high rotational speeds withminimal wind-up and with the structurally interconnected inner tubeeliminating the problems of disconnection or detachment of the innertube. The use of multiple spiral wrap layers over the helical cutreduces but does not eliminate the possibility of suction being lostfrom the lumen of the inner tube and/or irrigating fluid entering intothe lumen of the inner tube since the helical cut and spiral wraps stillpresent spaces for fluid flow between the outside and the inside of thetubular member. The use of a helically cut inner tube achieves a highdegree of bendability and allows flexibility to be imparted to the innertube adjacent the cutting configuration. However, each spiral wrap layeradds material and labor costs to the flexible inner tubular member and,therefore, to the angled tissue cutting instrument.

It would be desirable to provide an alternative construction for theflexible inner tubular members of angled tissue cutting instrumentswherein the flexible inner tubular members retain the benefits ofutilizing a helically cut inner tube and allowing torque transmission inforward and reverse rotational directions, while replicating a solidwall inner tubular member construction for increased aspiration andirrigation efficiencies and reduced risk of clogging, reducing wind-up,providing increased structural strength, and reducing the labor andmaterials needed to fabricate the flexible inner tubular members ofvarious diametric sizes of angled tissue cutting instruments havingangled outer members with angles of various magnitudes, radii ofcurvature and directions.

SUMMARY OF THE INVENTION

Accordingly, it is a primary object of the present invention to overcomethe aforementioned disadvantages of prior angled tissue cuttinginstruments and prior flexible inner tubular members of angled tissuecutting instruments.

Another object of the present invention is to increase the aspirationefficiency through the flexible inner tubular members of angled tissuecutting instruments.

A further object of the present invention is to decrease the risk ofclogging in angled tissue cutting instruments.

An additional object of the present invention is to improve irrigationefficiency through angled tissue cutting instruments.

It is also an object of the present invention to reduce wind-up in theflexible inner tubular members of angled tissue cutting instruments.

The present invention has as another object to lower the cost offlexible inner tubular members of angled tissue cutting instruments.

Yet a further object of the present invention is to reduce the labor andmaterials needed to fabricate the flexible inner tubular members ofangled tissue cutting instruments.

The present invention also has as an object to utilize helically cutinner tubes in the flexible inner tubular members of angled tissuecutting instruments while replicating a solid wall inner tubular memberconstruction.

The present invention has as another object to eliminate spaces throughthe overall wall thickness of flexible regions of the flexible innertubular members of angled tissue cutting instruments.

A still further object of the present invention is to prevent suction inthe lumen of a flexible inner tubular member of an angled tissue cuttinginstrument from being lost through the wall of the flexible innertubular member along a flexible region thereof.

Moreover, it is an object of the present invention to prevent irrigatingfluid flowing between the angled outer tubular member and the flexibleinner tubular member of an angled tissue cutting instrument from beingdrawn into the lumen of the flexible inner tubular member through thewall of the flexible inner tubular member along a flexible regionthereof.

Still a further object of the present invention is to increase thestructural strength of the flexible inner tubular members of angledtissue cutting instruments.

The aforesaid objects are achieved individually and in combination, andit is not intended that the present invention be construed as requiringtwo or more of the objects to be combined unless expressly required bythe claims attached hereto.

Some of the advantages of the present invention are that the cuttingconfiguration of the flexible inner tubular member may be a cutting tipformed integrally, unitarily with the inner tube or as a separatecomponent attached to a forward end of a body of the inner tube; variousdifferent cutting configurations can be used including end cutters, sidecutters, trimmers, resectors, shavers, abraders and burs; the cuttingconfiguration can be configured to produce various cutting actionsindependently or in cooperation with the distal end of the outer tubularmember including side cutting, end cutting, trimming, burring, abradingand resection; the inner tubular member can be angled or bent adjacentthe cutting configuration; the outer tubular member can include one or aplurality of angles at various locations along the length of the outertubular member; the angle or angles in the outer tubular member may beformed by various curves, bends or angles of various magnitudes andradii of curvature and may extend in various directions; the flexibleinner tubular member may have one or a plurality of flexible regions;plural flexible regions may be spaced longitudinally from one anotheralong the length of the inner tube for being disposed in the angles,respectively, of the outer tubular member; a single flexible region maybe of sufficient length to be disposed in more than one angle of theouter tubular member; irrigating fluid can be supplied along the angledtissue cutting instrument internally and/or externally for discharge ata cutting site; the inner tubular member can have one or more aspirationports at various locations for aspirating materials at the cutting siteinto the lumen or aspiration passage of the inner tubular member; theflexible inner tubular member can be fabricated in various diametricsizes for use in angled tissue cutting instruments of various sizesincluding 2.9 mm, 3.5 mm, 4.0 mm and 4.5 mm instruments; the angledtissue cutting instrument can be driven by any suitable powered surgicalhandpiece capable of rotating the inner tubular member relative to andwithin the outer tubular member; and the angled tissue cuttinginstrument is useful in various types of surgery including surgery ofthe head and neck as well as other types of surgery.

These and other objects, advantages and benefits are realized with thepresent invention as generally characterized in an angled tissue cuttinginstrument comprising an elongate angled outer tubular member and anelongate flexible inner tubular member rotatably disposed within theouter tubular member to transmit torque in forward and reverserotational directions. The outer tubular member includes a proximal end,a distal end, a bend between the proximal end and the distal end, and anopening at the distal end defining a cutting port in communication withthe lumen of the outer tubular member. The inner tubular membercomprises a proximal end, a distal end, an elongate tubular body betweenthe proximal end and the distal end of the inner tubular member, and acutting configuration at the distal end of the inner tubular member forexposure by the cutting port to cut anatomical tissue when the innertubular member is rotated within the outer tubular member. A continuoushelical cut is formed along a length portion of the tubular body, whichis of solid wall construction prior to the helical cut being formedtherein. The helical cut is formed in the tubular body at a helix anglein a first direction about the tubular body to impart flexibility alongthe length portion by which the inner tubular member conforms to theangled outer tubular member while being rotated within the angled outertubular member. A continuous solid flexible surface is secured to anouter surface of the tubular body. A flexible region of the innertubular member comprises the helically cut length portion of the tubularbody and the flexible surface secured to the outer surface of thetubular body along the helically cut length portion. The flexible regionis in correspondence with the bend in the angled outer tubular membersuch that the flexible region is disposed within and conforms to thebend while transmitting torque to the cutting configuration when theinner tubular member is rotated relative to and within the outer tubularmember in the forward and reverse rotational directions. The lumen ofthe tubular body defines an aspiration passage through the flexibleinner tubular member, and an aspiration port at the distal end of theinner tubular member is in communication with the aspiration passage. Anirrigation channel is defined between the inner diameter of the outertubular member and the outer diameter of the inner tubular member. Theflexible region replicates a solid wall tubular construction such thatsuction in the aspiration passage is not lost through the wall of theflexible region and irrigating fluid in the irrigating channel does notenter the aspiration passage through the wall of the flexible region.

The flexible surface may comprise a heat shrunk sleeve disposed over thehelically cut length portion. The flexible region may further include alayer of adhesive between the sleeve and the outer surface of thetubular body by which the sleeve is secured to the tubular body. Thehelical cut may be formed in the tubular body in a stepped patterncomprising repeating interconnected steps. Each step comprises atransverse cut segment extending transverse to the length of the tubularbody at the helix angle in the first direction and a longitudinal cutsegment extending from the transverse cut segment along the length ofthe tubular body. The transverse cut segment meets the longitudinal cutsegment at an outside corner forming a step configuration. Thelongitudinal cut segment extends from the transverse cut segment at theoutside corner to an inside corner at which the longitudinal cut segmentmeets the transverse cut segment of the next step. The steps repeat atabout 120 degree rotational intervals about a central longitudinal axisof the tubular body. In a preferred embodiment, the helix angle is 20degrees. The helical cut tightens as the inner tubular member is rotatedrelative to and within the outer tubular member in a forward rotationaldirection. The flexible surface prevents the tubular body from unwindingwhen the inner tubular member is rotated in a reverse rotationaldirection such that the inner tubular member transmits torque to thecutting configuration in both forward and reverse rotational directions.The bond between the flexible surface and the tubular body reduceswind-up in that clockwise and counterclockwise movements are restricted.

The present invention is further characterized in a method offabricating an angled tissue cutting instrument and, in particular, theflexible inner tubular member of an angled tissue cutting instrument.The method involves forming a continuous helical cut along a solid walllength portion of an elongate tubular body at a helix angle in a firstdirection about the tubular body to impart flexibility along the lengthportion, and securing a continuous solid flexible surface to an outersurface of the tubular body along the length portion to form a flexibleregion. The tubular body is inserted for rotation within an angled outertubular member with the flexible region disposed within a bend in theouter tubular member and a cutting configuration carried at a distal endof the tubular body exposed by a cutting port in a distal end of theouter tubular member. The step of securing may involve positioning aheat shrinkable sleeve over the helically cut length portion of thetubular body with an adhesive disposed between the sleeve and the outersurface of the tubular body, and applying heat to shrink the sleevediametrically over the tubular body.

Other objects and advantages of the present invention will becomeapparent from the following description of preferred embodiments takenin conjunction with the accompanying drawings, wherein like parts ineach of the several figures are identified by the same referencenumerals.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an exploded broken side view of an angled tissue cuttinginstrument according to the present invention.

FIG. 2 is a broken side view of an inner tube of the flexible innertubular member of the angled tissue cutting instrument of the presentinvention.

FIG. 3 is a broken side view of the inner tube with a helical cut formedin an elongate tubular body of the inner tube to impart flexibilityalong a length portion of the tubular body.

FIG. 4 is an enlarged detail view depicting a stepped pattern for thehelical cut in the tubular body.

FIG. 5 is a broken side view of the inner tube with an adhesive disposedover the helically cut length portion of the tubular body.

FIG. 6 is a broken side view of the inner tube depicting a heatshrinkable sleeve positioned over the helically cut length portion ofthe tubular body.

FIG. 7 is a broken side view illustrating the application of heat toshrink the sleeve diametrically over the tubular body to form theflexible inner tubular member.

FIG. 8 is an exploded broken side view of an alternative angled tissuecutting instrument according to the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

An angled tissue cutting instrument 10 according to the presentinvention is illustrated in FIG. 1 and comprises an elongate angledouter tubular member 12 and an elongate flexible inner tubular member 14for being rotatably disposed in angled outer tubular member 12. Theangled outer tubular member 12 is typically made of stainless steel andincludes a distal end 16, a proximal end 18 and a central longitudinalaxis 19 that follows a non-straight or angled longitudinal path. Theproximal end 18 is typically attached to an outer member hub 20, whichmay be made of plastic. An opening is formed in the distal end 16 anddefines a cutting port or window 22 providing communication with thelumen of the outer tubular member 12 from externally of distal end 16.The cutting port 22 can have various configurations and may becircumscribed by a peripheral edge. The peripheral edge thatcircumscribes the cutting port 22 can be a non-cutting edge or a cuttingedge as depicted for outer tubular member 12, which has a peripheralcutting edge 23 circumscribing the cutting port 22. The cutting edge 23can have various configurations to cut anatomical tissue including aseries of cutting teeth on opposite sides of axis 19 as shown forcutting edge 23. The outer member hub 20 may have a connector 24 incommunication with the lumen of the angled outer tubular member 12 bywhich irrigating fluid may be supplied to the lumen of the outer tubularmember 12 as described further below.

Angled outer tubular member 12 has one or more bends, curves or angles26, each of which may be of various magnitudes and radii of curvatureand may extend in various directions at various locations along thelength of the outer tubular member 12. Angled outer tubular member 12has a single bend 26 and includes a straight proximal length portion 28extending distally from outer member hub 20 to the bend 26 which isadjacent, near or close to the distal end 16. The central longitudinalaxis 19 of the outer tubular member 12 is contained in a plane, with thebend 26 extending downwardly in this plane from the proximal lengthportion 28 looking at FIG. 1. However, it should be appreciated that thecentral longitudinal axis 19 of the outer tubular member 12 does nothave to lie in or be contained in a plane and that the bend 26 mayextend upwardly, downwardly or laterally from the proximal lengthportion 28.

The flexible inner tubular member 14 includes a distal end 30, aproximal end 32 and a central longitudinal axis 33 of variableconfiguration due to flexibility of the inner tubular member 14. Theproximal end 32 is typically attached to an inner member hub 34, whichmay be made of plastic. The distal end 30 carries a cuttingconfiguration 36 that may have various configurations to cut anatomicaltissue. An opening is formed through the distal end 30 and defines anaspiration or suction port 38 in communication with an aspiration orsuction passage defined by the lumen 40 of the flexible inner tubularmember 14. The aspiration port 38 may have various configurations andmay be disposed at various locations on the inner tubular member 14. Thecutting configuration 36 may comprise a cutting edge circumscribing theaspiration port 38 as depicted for flexible inner tube member 14. Inparticular, the cutting configuration 36 illustrated for flexible innertubular member 14 comprises a peripheral cutting edge circumscribing theaspiration port 30 and comprising a series of cutting teeth on oppositesides of axis 33. In the case of angled tissue cutting instrument 10,the cutting configuration 36 of the inner tubular member 14 cooperateswith the cutting edge 23 of the outer tubular member 12 to cutanatomical tissue. However, it should be appreciated that the cuttingconfiguration 36 of the inner tubular member 14 can cut anatomicaltissue independently, without there being a cooperating cutting edge onthe outer tubular member 12.

The outer and inner member hubs 20 and 34 are ordinarily coupled with apowered surgical handpiece (not shown) for rotating the inner tubularmember 14 relative to and within the outer tubular member 12. Thepowered surgical handpiece maintains the longitudinal position of theouter and inner members 12 and 14 relative to one another so that thecutting configuration 36 is exposed by or from the cutting port 22 toaccess and cut anatomical tissue as the inner tubular member 14 isrotated within the outer tubular member 12. A representative poweredsurgical handpiece is disclosed in U.S. Pat. No. 5,916,231 to Bays, theentire disclosure of which is incorporated herein by reference. Asdescribed above, the outer member 12 may have a cutting edge 23 thatcooperates with the cutting configuration 36 to effect tissue cutting.There is sufficient annular space between the inner diameter of outermember 12 and the outer diameter of inner member 14 to define anirrigation channel between the outer and inner members for the flow ofirrigating fluid supplied to the lumen of the outer member 12 throughconnector 24.

In order to access anatomical tissue in a cutting procedure, the angledtissue cutting instrument 10 is typically introduced through a naturalor surgically created anatomical opening or passage in a patient's bodyto position the distal end 16 of the outer tubular member 12 at acutting site in the patient's body while the handpiece is maintainedexternally of the patient's body. Exposure of the cutting configuration36 by or from the cutting port 22 allows anatomical tissue at thecutting site to be accessed and cut by the cutting configuration. Theaspiration port 38 establishes communication between the cutting siteand the lumen or aspiration passage 40 of the flexible inner tubularmember 14 and, when suction is produced in the lumen 40, typically viathe handpiece, materials such as tissue debris are drawn into the lumen40 via the aspiration port 38 for aspiration from the patient's body.Where the cutting configuration 36 comprises a cutting edgecircumscribing the aspiration port 38, the cutting configuration andaspiration port register with the cutting port 22, and the cutting edge23 if provided, as the inner member 14 rotates within the outer member12. Irrigating fluid may be supplied to the irrigation channel betweenthe outer and inner tubular members 12 and 14 for discharge at thecutting site through the cutting port 22. A source of irrigating fluidmay be coupled with the connector 24 to supply the irrigating fluid tothe lumen of outer member 12 for flow between the inner diameter of theouter tubular member 12 and the outer diameter of the flexible innertubular member 14.

The flexible inner tubular member 14 has one or more flexible regions 42for transmitting torque to rotate the cutting configuration 36 when theinner member 14 is rotated relative to and within the outer member 12 inforward and reverse rotational directions, while allowing the innertubular member 14 to conform to the angled configuration of the outertubular member 12 as it is rotated therein. The flexible inner tubularmember 14 has one flexible region 42 of sufficient length to extendwithin the bend 26 so that the inner tubular member 14 conforms to thebend 26 while being rotatable within the outer tubular member 12.Accordingly, the flexible region 42 is disposed at a location along thelength of the inner tubular member 14 in correspondence with the bend 26in the outer tubular member 12.

FIGS. 2-7 illustrate the flexible inner tubular member 14 as well as amethod of fabricating the flexible inner tubular member 14. As shown inFIG. 2, the flexible inner tubular member 14 comprises an elongate innertube 44, which may be made of stainless steel, presenting an elongatetubular body 45 extending between distal end 30 and proximal end 32. Theproximal end 32 of the inner tubular member 14 may be defined by arearward or proximal end of the inner tube 44. The inner tube 44 may beknurled along the proximal end 32 to facilitate attachment of the innertube 44 to the inner member hub 34. The distal end 30 of the flexibleinner tubular member 14 may be made of stainless steel and may be formedintegrally, unitarily or monolithically with the inner tube 44 or as aseparate component attached to a forward or distal end of the elongatebody 45 of inner tube 44. The lumen 40 of the inner tube 44 defines theaspiration passage of the flexible inner tubular member 14. The distalend 30 may comprise a cutting tip, which may be hollow to establishcommunication between the aspiration port 38 and the lumen 40 throughinner tube 44. The inner tube 44 is longitudinally or axially straightand is of unbroken solid wall construction along the body 45, and atleast along the flexible region 42. flexible inner tubular member 14comprises an elongate inner tube 44, which may be made of stainlesssteel, presenting an elongate tubular body 45 extending between distalend 30 and proximal end 32. The proximal end 32 of the inner tubularmember 14 may be defined by a rearward or proximal end of the inner tube44. The inner tube 44 may be knurled along the proximal end 32 tofacilitate attachment of the inner tube 44 to the inner member hub 34.The distal end 30 of the flexible inner tubular member 14 may be made ofstainless steel and may be formed integrally, unitarily ormonolithically with the inner tube 44 or as a separate componentattached to a forward or distal end of the elongate body 45 of innertube 44. The lumen 40 of the inner tube 44 defines the aspirationpassage of the flexible inner tubular member 14. The distal end 30 maycomprise a cutting tip, which may be hollow to establish communicationbetween the aspiration port 38 and the lumen 40 through inner tube 44.The inner tube 44 is longitudinally or axially straight and is ofunbroken solid wall construction along the body 45, and at least alongthe flexible region 42.

As shown in FIG. 3, a continuous helical cut 46 is formed in the body 45of inner tube 44 along a length portion of the body 45 corresponding tothe flexible region 42. The helical cut 46 is continuous from end to endand is formed in the inner tube 44 at a helix angle A in a firstdirection, i.e. clockwise (right hand) or counterclockwise (left hand),about the central longitudinal axis 33 of the inner tube 44 as depictedin FIGS. 3 and 4.

The helical cut 46 is formed in the inner tube 44 in a stepped pattern,best shown in FIG. 4, comprising repeating interconnected steps 48.However, the helical cut 46 can be formed in various other patternsincluding a plain helix or spiral without any steps. Each step 48includes a transverse or circumferential cut segment 50 extendingtransverse to the length of the inner tube 44 and its body 45 in thefirst direction about the axis 33 of the inner tube 44 and its body 45,and a longitudinal cut segment 52 extending along the length of theinner tube 44 and its body 45 from the transverse cut segment 50 to thetransverse cut segment 50 of the next step. The transverse cut segment50 extends in the first direction about axis 33 at the helix angle A toa plane P perpendicular to the central longitudinal axis 33. Thetransverse cut segment 50 and the longitudinal cut segment 52 of thestep 48 meet at an outside corner 54 to form a step configuration. Thelongitudinal cut segment 52 extends from the transverse cut segment 50at the outside corner 54 to meet the transverse cut segment 50 of thenext step at an inside corner 56. The transverse cut segment 50 meetsthe longitudinal cut segment of the previous step at the previous insidecorner. The helical cut 46 may be of uniform pitch along the lengthportion as shown in FIG. 3, or may be of non-uniform pitch along thelength portion to vary the flexibility of the inner tube 44 along thelength portion.

Each transverse cut segment 50 defines the helix angle A with a plane Pperpendicular to the central longitudinal axis 33 of the inner tube 44.The longitudinal cut segments 52 are shorter in length than thetransverse cut segments 50, and the longitudinal cut segments 52 may beparallel to the central longitudinal axis 33. The steps 48 repeat atabout 120° rotational intervals about the central longitudinal axis 33,with the outside corner 54 rotationally offset about 120° about axis 33from the inside corner 56 of the previous step. In a preferredembodiment, the helix angle A is about 20° in a left hand firstdirection. However, the helical cut 46 may extend in the right handdirection, and the helix angle A can be other than about 20° in the leftor right hand directions. Preferably, the helical cut 46 is formed inthe inner tube 44 by laser cutting. The helical cut 46 may extend allthe way to the cutting tip of the flexible inner tubular member toimpart flexibility to the inner tube 44 adjacent the cutting tip. Thehelical cut 46 extends entirely through the wall thickness of inner tube44 to impart flexibility while the inner tube remains materially andstructurally interconnected.

As illustrated in FIG. 5, the flexible inner tubular member 14 furthercomprises a coating or layer of adhesive 58 disposed over the outersurface of the elongate body 45 of inner tube 44 along the helically cutlength portion thereof corresponding to flexible region 42. The coatingor layer of adhesive 58 may be applied to the outer surface of innertube 44 in various ways including spraying the adhesive on the outersurface of the inner tube. Representative but not limiting adhesivesinclude 3M Hi-Strength 90 spray adhesive and 3M High-Tack 76 sprayadhesive. As shown in FIG. 5, a mandrel 60 may be disposed within thelumen 40 of the inner tube 44 with a close fit and of sufficient lengthto extend within the helically cut length portion and prevent theadhesive 58 from entering the lumen 40 through the helical cut 46.

FIG. 6 depicts a heat shrinkable sleeve 62 position or disposed over theadhesively coated and helically cut length portion of the inner tube 44.The sleeve 62 has an inner diameter receiving the outer diameter of theadhesively coated and helically cut length portion of inner tube 44 witha loose fit to facilitate sliding the sleeve 62 into position on theadhesively coated and helically cut length portion of the inner tube 44corresponding to flexible region 42. FEP (fluorinated ethylenepropylene) shrink tubing may be used as the sleeve 62. Other materialswhich may be suitable for sleeve 62 include polyester and polyolefin aswell as other heat shrinkable materials. The sleeve 62 may have a wallthickness of about 0.010 inch and may have any suitable shrink ratio toobtain a close or snug fit over the inner tube 44 in response to theapplication of heat as described below. As an example, the sleeve 62 mayhave a 1.3 to 1 shrink ratio.

FIG. 7 depicts heat being applied to the sleeve 62 to shrink the sleevediametrically to obtain a close or snug fit with the outer surface ofinner tube 44 along the length portion. Heat can be applied in variousways including the use of induction heaters and heat guns. The heatshrunk sleeve 62 sandwiches the adhesive 58 between the outer surface ofthe inner tube 44 and the inner diameter of the sleeve 62, and themandrel 60 may be used to prevent the adhesive from entering lumen 40through helical cut 46. The adhesive 58 is bonded to the inner tube 44and the sleeve 62. The flexible region 42 of the flexible inner tubularmember 14 thusly comprises the helically cut length portion of innertube 44 corresponding to flexible region 42, and a continuous solidflexible surface secured to the outer surface of the elongate body 45along the helically cut length portion. The flexible surface maycomprise sleeve 62, and the flexible surface may be secured to the outersurface of the inner tube 44 via the layer of adhesive 58 disposedbetween the flexible surface and the outer surface of the inner tube.

The flexible region 42 is capable of transmitting torque to rotate thecutting configuration 36 when the flexible inner tubular member 14 isdisposed within the outer tubular member 12 while allowing the flexibleinner tubular member 14 to conform to the angled configuration of theouter tubular member 12 as it is rotated therein. The flexible region 42is capable of transmitting torque when the flexible inner tubular member14 is rotated relative to and within the angled outer tubular member 12in both forward and reverse rotational directions. The bond betweenadhesive 58 and the inner tube 44 and the sleeve 62 reduces wind-up ofthe flexible inner tubular member 14 in that clockwise andcounterclockwise movements are restricted. Also, the heat shrunk sleeve62 prevents the inner tube 44 from unwinding. The heat shrunk sleeve 62is disposed over the entire helically cut length portion of the innertube 44 and is bonded to the inner tube 44 such that the flexible region42 replicates a solid wall tube construction in that no spaces oropenings are presented along the outer surface of the flexible region42. The wall thickness of the flexible region 42 comprises the wallthickness of the helically cut length portion of inner tube 44, thenominal thickness of adhesive 58 and the wall thickness of heat shrunksleeve 62. Thus, the flexible region 42 comprises an inner wall,corresponding to the helically cut length portion of inner tube 44,along the inner diameter of the inner tubular member 14, and an outerwall, corresponding to solid surface 62 covering the helically cutlength portion, along an outer diameter of the flexible inner tubularmember 14. The wall thickness of the flexible region 42 is solid alongits outer surface or diameter due to the solidity of the outer wallcorresponding to solid surface or sleeve 62. Since there are no openingsor spaces which go entirely through the wall thickness of flexibleregion 42 and since there are no openings or spaces along the outersurface or diameter of flexible region 42 which are in communicationwith the lumen 40, suction produced in the lumen or aspiration passage40 is not lost through the wall thickness of the flexible region 42.Furthermore, irrigating fluid supplied between the angled outer tubularmember 12 and the flexible inner tubular member 14 is not drawn into thelumen 40 along the flexible region 42 and body 45 of the inner tube 44since there are no openings or spaces through the entire wall thicknessof the flexible region 42 by which the irrigating fluid may enter thelumen 40. Aspiration efficiency is thusly increased in the angled tissuecutting instrument 10 in that the suction force in the aspirationpassage 40 is more effectively applied at the aspiration port 38 withoutloss of suction along the body 45 of the flexible inner tubular member14. Irrigation efficiency is also increased in the angled tissue cuttinginstrument 10 since irrigating fluid flowing in the irrigation channelbetween the outer and inner members 12 and 14 is more effectivelydischarged from the cutting port 22 since irrigating fluid is not lostalong the body 45 of the flexible inner tubular member by being drawninto the lumen 40. The flexible inner tubular member 14 and, therefore,the angled tissue cutting instrument 10, can be fabricated at lower costdue to savings in materials and labor over prior flexible inner tubularmembers for angled tissue cutting instruments.

An alternative angled tissue cutting instrument is illustrated in FIG. 8at 110. Angled tissue cutting instrument 110 is similar to angled tissuecutting instrument 10 except that angled outer tubular member 112 forangled tissue cutting instrument 110 has two bends 126 and flexibleinner tubular member 114 of angled tissue cutting instrument 110 has twoflexible regions 142 in correspondence with the bends 126, respectively.The bends 126 may have the same or different angles and/or radii ofcurvature and may extend in the same or different directions at variouslocations along the outer tubular member 112. In the angled tissuecutting instrument 110, the proximal bend 126A has a greater angle and agreater radius of curvature than the angle and radius of curvature ofthe distal bend 126B. Looking at FIG. 8, the proximal bend 126A extendsdownwardly while the distal bend 126B extends upwardly in the plane ofaxis 119. However, it should be appreciated that the bends 126A, 126Bcan extend upwardly, downwardly, or laterally and do not have to becontained in the same plane.

Flexible inner tubular member 114 comprises proximal flexible region142A and distal flexible region 142B corresponding to the proximal anddistal bends 126A and 126B, respectively. Each flexible region of theinner tubular member 114 is constructed in the same manner as theflexible region 42 and comprises a helically cut length portion of theinner tube 144 corresponding to the flexible region, a layer or coatingof adhesive along the helically cut length portion of the inner tube144, and a heat shrunk sleeve 162 diametrically shrunk over theadhesively coated helically cut length portion. The flexible innertubular member 114 is rotatably disposed within the angled outer tubularmember 112 with the flexible regions 142A and 142B disposed within thebends 126A and 126B, respectively, to transmit torque to the cuttingconfiguration 136 when the flexible inner tubular member 114 is rotatedwithin the angled outer tubular member 112, and the flexible regions142A, 142B allow the inner tubular member 114 to confirm to the angledconfiguration of the outer tubular member 112 as it is rotated therein.

Inasmuch as the present invention is subject to many variations,modifications and changes in detail, it is intended that all subjectmatter discussed above or shown in the accompanying drawings beinterpreted as illustrative only and not be taken in a limiting sense.

1. An angled tissue cutting instrument comprising an elongate angledouter tubular member comprising a distal end, a proximal end, a bendbetween said distal end and said proximal end, and an opening at saiddistal end defining a cutting port; and an elongate flexible innertubular member rotatably disposed in said outer tubular member andcomprising a distal end, a proximal end, an elongate tubular bodybetween said distal end of said inner tubular member and said proximalend of said inner tubular member, a cutting configuration at said distalend of said inner tubular member for exposure by said cutting port tocut anatomical tissue when said inner tubular member is rotated withinsaid outer tubular member, a flexible region along said body disposed insaid bend to transmit torque to said cutting configuration when saidinner tubular member is rotated in forward and reverse rotationaldirections, said flexible region comprising a continuous helical cutformed along a length portion of said body corresponding to said bend, acoating of adhesive disposed over an outer surface of said body alongsaid length portion, and a heat shrunk sleeve disposed over said lengthportion with a close diametric fit, with said adhesive bonding saidsleeve to said outer surface of said body along said length portion. 2.The angled tissue cutting instrument recited in claim 1 wherein saidhelical cut is formed through the wall thickness of said body at a helixangle in a first direction about a central longitudinal axis of saidflexible inner tubular member.
 3. The angled tissue cutting instrumentrecited in claim 2 wherein said helix angle is about 20° and said firstdirection is a left hand direction about said central longitudinal axisof said inner tubular member.
 4. The angled tissue cutting instrumentrecited in claim 2 wherein said helical cut is formed in a steppedpattern comprising repeating interconnected steps.
 5. The angled tissuecutting instrument recited in claim 4 wherein each step repeats atrotational intervals of about 120° about said central longitudinal axisof said inner tubular member.
 6. The angled tissue cutting instrumentrecited in claim 4 wherein each of said steps comprises a transverse cutsegment extending transverse to the length of said body at said helixangle to a plane perpendicular to said central longitudinal axis of saidinner tubular member and a longitudinal cut segment extending from saidtransverse cut segment along the length of said body.
 7. The angledtissue cutting instrument recited in claim 1 wherein said adhesivecomprises a spray adhesive.
 8. The angled tissue cutting instrumentrecited in claim 1 wherein said sleeve is made of fluorinated ethylenepropylene.
 9. The angled tissue cutting instrument recited in claim 8wherein said sleeve has a thickness of about 0.010 inch and a shrinkratio of about 1.3 to
 1. 10. An angled tissue cutting instrumentcomprising an elongate angled outer tubular member comprising a distalend, a proximal end, a bend between said distal end and said proximalend, and an opening in said distal end defining a cutting port; and anelongate flexible inner tubular member rotatably disposed in said outertubular member and comprising a distal end, a proximal end, an elongatetubular body between said distal end and said proximal end of said innertubular member, a cutting configuration at said distal end of said innertubular member for exposure by said cutting port to cut anatomicaltissue when said inner tubular member is rotated within said outertubular member, and a flexible region along said body disposed withinsaid bend, said flexible region comprising an outer wall along an outerdiameter surface of said inner tubular member and an inner wall along aninner diameter surface of said inner tubular member, said outer wallbeing secured to said inner wall, said inner wall comprising a helicallycut length portion of said body having a cut through the wall thicknessof said body extending helically along said length portion, said outerwall comprising a continuous solid flexible surface covering saidhelically cut length portion.
 11. The angled tissue cutting instrumentrecited in claim 10 wherein said flexible surface is adhesively securedto an outer surface of said body.
 12. The angled tissue cuttinginstrument recited in claim 10 wherein said flexible surface comprises aheat shrunk sleeve receiving said helically cut length portion therein.13. The angled tissue cutting instrument recited in claim 10 whereinsaid cut is formed through said wall thickness of said body in a steppedpattern.
 14. The angled tissue cutting instrument recited in claim 10wherein said outer tubular member has a lumen receiving said innertubular member and further comprising an aspiration port in said distalend of said inner tubular member and an aspiration passage through saidbody in communication with said aspiration port, wherein said flexiblesurface prevents communication between said aspiration passage and saidlumen along said flexible region.
 15. The angled tissue cuttinginstrument recited in claim 10 wherein said outer tubular member has alumen in communication with said cutting port, said inner tubular memberis received in said lumen, said lumen defines an irrigation channel forreceiving irrigating fluid between said outer tubular member and saidinner tubular member for discharge through said cutting port, said bodyhas a lumen, wherein said flexible surface prevents communicationbetween said lumen of said body and said irrigation channel along saidflexible region.
 16. The angled tissue cutting instrument recited inclaim 10 wherein said outer tubular member includes a plurality of saidbends and said inner tubular member includes a plurality of saidflexible regions disposed within said bends, respectively.
 17. A methodof fabricating an angled tissue cutting instrument having a flexibleinner tubular member, comprising the steps of forming a helical cutalong a length portion of a solid wall elongate tubular body to impartflexibility along the length portion; applying a coating of adhesiveover an outer surface of the tubular body along the helically cut lengthportion; positioning a heat shrinkable sleeve over the adhesively coatedhelically cut length portion such that the length portion extendsthrough the sleeve; applying heat to shrink the sleeve diametricallyover the length portion with the adhesive bonding the sleeve to thetubular body; and inserting the tubular body for rotation within anangled outer tubular member with the length portion disposed within abend of the outer tubular member to conform to the configuration of theouter tubular member when the tubular body is rotated within the outertubular member to cut anatomical tissue via a cutting configurationconnected with a distal end of the tubular body and exposed from acutting port of the outer tubular member.
 18. The method recited inclaim 17 wherein said step of forming includes laser cutting the helicalcut in the tubular body in a stepped pattern.
 19. The method recited inclaim 18 wherein said step of forming includes forming the helical cutat a helix angle in a first direction about a central longitudinal axisof the tubular body.
 20. The method recited in claim 19 wherein saidstep of forming includes forming the helical cut at a helix angle ofabout 20° in a left hand direction about the central longitudinal axisof the tubular body.
 21. The method recited in claim 18 wherein saidstep of forming includes forming the helical as repeating steps with thesteps repeating at rotational intervals of about 120° about a centrallongitudinal axis of the tubular body.
 22. The method recited in claim17 and further including, prior to said step of applying, the step ofpositioning a mandrel within the lumen of the tubular body along thehelically cut length portion and, prior to said step of inserting, thestep of removing the mandrel from the tubular body.
 23. The methodrecited in claim 17 wherein said step of applying a coating of adhesiveincludes spraying the adhesive on the outer surface of the tubular bodyalong the helically cut length portion.
 24. The method recited in claim17 wherein said step of positioning includes positioning the helicallycut length portion to extend through a sleeve made of fluorinatedethylene propylene.
 25. The method recited in claim 17 wherein said stepof applying heat includes applying heat by induction heating.
 26. Themethod recited in claim 17 where said step of inserting includesproviding an irrigation channel between the inner tubular member and theouter tubular member for the flow of irrigating fluid along theinstrument.